Hypertension and nephrology

[Perindopril plus Indapamid CombinAtion blood preSSure reductiOn study (PICASSO)]

APRIL 20, 2011

Hypertension and nephrology - 2011;15(02)

[INTRODUCTION - International and Hungarian (JNC-7, ESH/ESC2007 és 2009, MHT 2009) Guidelines suggest a target blood pressure <140/90 mmHg for hypertensive patients, and <130/80 mmHg for those with high/very high cardiovascular risk (e.g. patients with diabetes mellitus, chronic renal disease). It was proved that for achieving the most efficient antihypertensive effect and reducing side effects, thd use of drug combinations is needed in most patients. In Hungary, ACE-inhibitor plus diuretic combination is one of the most frequently used one in Hungary. The vérnyomáscsökaim of the PICASSO study was to evaluate the efficacy and metabolic effects of the fixed combination of high-dose perindopril plus indapamide (Coverex-AS Komb Forte®) in clinical practice of hypertonologists, cardiologists and general practicioners. PATIENTS AND METHODS - Patients with uncontrolled, grade 1 or 2 primary hypertension, age, >18 years were involved in the open, 3-month, multicentre, prospective, observational, non-interventional clinical study if the treating physician indicated a combination treatment with higher dose antihypertensive drugs. Blood pressure (also with ABPM), heart rate, metabolic parameters (plasma lipids, blood sugar, Na, K, creatinine, uric acid, GGT) were measured by routine methods, medical history and quality of life parameters were registered on a validated questionnaire. Changes in the above parameters were also separately evaluated in patients with different risk factors or with concomitant diseases. RESULTS - Data of 9683 patients were evaluated (54% women, 46% men, average age 61.8 years). By the end of the therapy used in the study, blood pressure average decreased from 159/93 to 131/80, by ABPM from 145/83 to 126/74 mmHg (24hr averages, systolic/diastolic blood pressure, respectively), the heart rate from 79 to 73 beats/min (p<0,001). Target blood pressure was achieved in 75,4% of patients with no major concomitant disease, but only in 14% of those with a concomitant disease characterised by lower target blood pressure. The diurnal index by ABPM did not change substantially. Clinically significant decreases were found in the plasma levels of total cholesterol, LDL-cholesterol, triglycerides, fasting glucose and uric acid levels, but there were no major changes in serum levels of HDLcholesterol, Na, K, and GGT. Quality of life parameters significantly improved by the end of the study. CONCLUSIONS - Combinations of perindopril and indapamide can be successfully and safely used in everyday practice.]



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KISS István, PÁL László, SCHANBERG Zsolt, BARNA István, ALFÖLDI Sándor, FARSANG Csaba, CHÁTEL de Rudolf, KÉKES Ede

[One of the potentials of the effective fight against endemic diseases is their exposition and the recognition of their dangers and risk factors. The other possibility is to increase the professional knowledge of the medical and healthcare employees along with the patients’ co-operation. For the prevention of complications and the adequate treatment of hypertension an extensive compliance program, called „Live below 140/90!” was initiated by the Hungarian Society of Hypertension in 2005. The mission was to give knowledge to the non-professional public about the symptoms of the disease and how to get information about it while helping patients’ relatives. The first message was the “Hit the target blood pressure value!”. With careful planning, treatment and taking of medicines the next phase could begin. The ratio of the patients who reached the target blood pressure increased by 5% during the two years of the Program between 2005 and 2007 therefore the message changed to “Hold the blood pressure there!”. The next step in the Program was to prevent the forming of complications and to treat the co-morbidities effectively among patients with pre-diabetes or diabetes and hypertension in 2008. The slogan was “Prevent the complications!”. As part of the Program we organized a roadshow named the “Day of caring!” and we announced the “Conscious Care” substudy focused on the public summoning about the stroke which is the most dangerous complication of hypertension. The year of 2011 is an absolutely new beginning in the communication of the Program since we started to use some very modern tools of the 21st century including YouTube, Facebook and others for the better education of the people. Based on the results of the initial Program we got to know the risks, co-morbidities, complications and the characteristics of the Hungarian hypertensive patients. We have recognized that most of the patients belong to the high and very high risk hypertensive category. Also more than 30 percent of them have a pre-diabetes condition. We have found that increased caring helps to build up the patients’ co-operation which in return improves the decrease of their blood pressure significantly. The Program therefore continues in 2011! Our intention is to enlarge the Hungarian Hypertension Register database and to get to know more and more epidemiologic and therapeutic features of the hypertension disease.]

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